Toenail fungus is not just a cosmetic problem -- it's an infection of the nail. Fungal infection, a condition called onychomycosis (ON-i-ko-my-KO-sis), is caused by organisms called dermatophytes; it's extremely common, affecting more than 35 million people in the United States (U.S.) alone. However, some 90 percent of these persons have yet to see a doctor for treatment. It is estimated that 2.5 million Americans see a podiatrist annually for treatment of toenail fungus, however many more are infected but never seek help because they consider toenail fungus just a cosmetic problem that doesn't need to be treated and cured.
Toenail fungus affects two to 18 percent of all people worldwide and three to five percent of the people in the U.S. It is relatively rare in children, affecting only about one out of every 200 people younger than 18. The likelihood of getting toenail fungus increases with age, and almost 50 percent of people have at least one infection by the time they reach age 70.

Risk factors
Anyone who wears tight-fitting shoes or tight hosiery is more likely to develop toenail fungus, especially if they also practice poor foot hygiene. Another risk factor is wearing layers of toenail polish for a long time, which doesn't allow the nail to breathe. Toenail fungi may spread from foot to foot on the floors of showers and locker rooms. More often the condition affects people with chronic illnesses, such as diabetes or HIV, as well as people with circulatory problems that decrease blood flow to the toes. Many people have no identifiable risk factors for getting toenail fungus.
Of all the toenails, those on the big toe and little toe are the most likely to develop a toenail fungus. This is because the big toe and little toe are constantly exposed to the mild trauma or friction from the sides of shoes. This trauma allows the fungus to enter the nail. Once these tiny organisms find their way under a nail, they begin to grow. Ironically, the nail itself provides a protective environment for the fungus to grow and thrive. The toenails are vulnerable to infection, since they spend most of their day in a dark, warm, and often moist environment in shoes and socks. This is the ideal environment for the fungus to grow.

Symptoms
When a fungal nail infection begins to take hold, it can cause the nail to change color -- often to a yellow/green, brown darker color or black. Fungal debris may collect under the nail causing a foul smell. The nail may thicken and become flaky. Thick toenails may cause discomfort in shoes and make standing and walking uncomfortable for some people. They can also cause ulcers on the nail bed that may not heal -- especially in diabetics. Moreover, because a fungal nail infection is an infection, it can spread to other nails, and possibly to other people. Something as ordinary as an emery board can carry the fungal organisms from an infected nail to an uninfected one, that's why it is so important to seek treatment as soon as you think you have an infection. Your podiatrist may take clippings off your nail to send to the lab to confirm the diagnosis before starting treatment.

Causes
Fungal nail infection has little to do with personal cleanliness. Something as simple as banging a toe or finger, trimming your nails too closely, or wearing tight shoes is enough to weaken the nail and expose the underlying nail bed to infection. The fungus that causes the infection resides in many common places -- locker rooms, swimming pools, showers or even your garden. You can also contract the infection while getting a manicure or pedicure from unsterilized instruments that have been used on others with the infection. Some people have diseases that make them more susceptible to fungal nail infections. People with chronic diseases such as diabetes, circulatory problems, cancer, and immunological deficiencies (such as AIDS/HIV infection) and the elderly are all at increased risk. Moreover, fungal nail infection appears to be more prevalent in those with a history of athlete's foot (a fungal infection of the skin) and people whose feet sweat a lot.

Treatment
A fungal nail infection won't go away by itself. There are almost as many home remedies as there are infections, but they do not work. The most effective treatments are only available from your doctor and may include one or a combination of topical, oral, laser or surgical methods. The fungal infection can be treated and cured but it takes time -- around 10 to 12 months based on the severity of the infection.

What you can do
Proper foot hygiene and regular inspection of the feet and toes are the first lines of defense against fungal nails. Here are a few steps you can take during and after your treatment to better care for your toenails.
o Washing the feet with soap and water daily and remembering to dry thoroughly is the best way to prevent an infection. Clean, dry feet resist disease.
o Shower shoes should be worn in public areas.
o Shoes with clean socks, or hosiery should be worn and changed daily.
o Toenails should be clipped straight across so that the nail does not extend beyond the tip of the toe.
o Wear shoes that are not too tight but fit well and are made of materials that breathe such as leather or canvas.
o Avoid wearing excessively tight hosiery, as it promotes moisture.
o Wear socks made of synthetic fiber, which tend to wick away moisture faster than cotton or wool socks.
o Use a separate pair of clippers and file on the infected nail to avoid spreading the infection to other nails. Disinfect instruments used for nail care and pedicures.
o Don't apply polish to nails suspected of being infected with a fungus.
o Consider replacing old footwear, as this could be contaminated with fungal spores.
o Have an athlete's foot infection treated with antifungal medicine as soon as possible to avoid spreading the infection to your nails.
During your treatment you will start to see a new healthy nail growing from the base of the nail bed. This is the sign that the treatment is working. The old infected nail should begin to grow out and can be clipped away over several months until only clear healthy nail remains. Nail regrowth takes some time, on average as long as 10 months, so be patient.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

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